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The Impact of Nutrition on the COVID-19 Pandemic and the Impact of the COVID-19 Pandemic on Nutrition

Relation of Serum Copper Status to Survival in COVID-19

Institute for Experimental Endocrinology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, D-10115 Berlin, Germany
Bundeswehr Hospital Berlin, Clinic of Traumatology and Orthopaedics, D-10115 Berlin, Germany
Department of General Practice and Health Services Research, Heidelberg University Hospital, D-69120 Heidelberg, Germany
ATORG, Center for Orthopaedics, Aschaffenburg Trauma and Orthopaedic Research Group, Trauma Surgery and Sports Medicine, Hospital Aschaffenburg-Alzenau, D-63739 Aschaffenburg, Germany
Orthopedic and Trauma Surgery, Frohsinnstraße 12, D-63739 Aschaffenburg, Germany
Author to whom correspondence should be addressed.
Academic Editor: Catherine L. Carpenter
Nutrients 2021, 13(6), 1898;
Received: 29 April 2021 / Revised: 28 May 2021 / Accepted: 30 May 2021 / Published: 31 May 2021
The trace element copper (Cu) is part of our nutrition and essentially needed for several cuproenzymes that control redox status and support the immune system. In blood, the ferroxidase ceruloplasmin (CP) accounts for the majority of circulating Cu and serves as transport protein. Both Cu and CP behave as positive, whereas serum selenium (Se) and its transporter selenoprotein P (SELENOP) behave as negative acute phase reactants. In view that coronavirus disease (COVID-19) causes systemic inflammation, we hypothesized that biomarkers of Cu and Se status are regulated inversely, in relation to disease severity and mortality risk. Serum samples from COVID-19 patients were analysed for Cu by total reflection X-ray fluorescence and CP was quantified by a validated sandwich ELISA. The two Cu biomarkers correlated positively in serum from patients with COVID-19 (R = 0.42, p < 0.001). Surviving patients showed higher mean serum Cu and CP concentrations in comparison to non-survivors ([mean+/−SEM], Cu; 1475.9+/−22.7 vs. 1317.9+/−43.9 µg/L; p < 0.001, CP; 547.2.5+/−19.5 vs. 438.8+/−32.9 mg/L, p = 0.086). In contrast to expectations, total serum Cu and Se concentrations displayed a positive linear correlation in the patient samples analysed (R = 0.23, p = 0.003). Serum CP and SELENOP levels were not interrelated. Applying receiver operating characteristics (ROC) curve analysis, the combination of Cu and SELENOP with age outperformed other combinations of parameters for predicting risk of death, yielding an AUC of 95.0%. We conclude that the alterations in serum biomarkers of Cu and Se status in COVID-19 are not compatible with a simple acute phase response, and that serum Cu and SELENOP levels contribute to a good prediction of survival. Adjuvant supplementation in patients with diagnostically proven deficits in Cu or Se may positively influence disease course, as both increase in survivors and are of crucial importance for the immune response and antioxidative defence systems. View Full-Text
Keywords: trace element; inflammation; ceruloplasmin; micronutrient; COVID-19 trace element; inflammation; ceruloplasmin; micronutrient; COVID-19
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MDPI and ACS Style

Hackler, J.; Heller, R.A.; Sun, Q.; Schwarzer, M.; Diegmann, J.; Bachmann, M.; Moghaddam, A.; Schomburg, L. Relation of Serum Copper Status to Survival in COVID-19. Nutrients 2021, 13, 1898.

AMA Style

Hackler J, Heller RA, Sun Q, Schwarzer M, Diegmann J, Bachmann M, Moghaddam A, Schomburg L. Relation of Serum Copper Status to Survival in COVID-19. Nutrients. 2021; 13(6):1898.

Chicago/Turabian Style

Hackler, Julian, Raban Arved Heller, Qian Sun, Marco Schwarzer, Joachim Diegmann, Manuel Bachmann, Arash Moghaddam, and Lutz Schomburg. 2021. "Relation of Serum Copper Status to Survival in COVID-19" Nutrients 13, no. 6: 1898.

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